Efficacy of Coxsackievirus A21 against drug-resistant neoplastic B cells

Primary drug resistance and minimal residual disease are major challenges in the treatment of B cell neoplasms. Therefore, this study aimed to identify a novel treatment capable of eradicating malignant B cells and drug-resistant disease. Oncolytic viruses eradicate malignant cells by direct oncolysis and activation of anti-tumor immunity, have proven anti-cancer efficacy, and are safe and well tolerated in clinical use. Here, we demonstrate that the oncolytic virus coxsackievirus A21 can kill a range of B cell neoplasms, irrespective of an anti-viral interferon response. Moreover, CVA21 retained its capacity to kill drug-resistant B cell neoplasms, where drug resistance was induced by co-culture with tumor microenvironment support. In some cases, CVA21 efficacy was actually enhanced, in accordance with increased expression of the viral entry receptor ICAM-1. Importantly, the data confirmed preferential killing of malignant B cells and CVA21 dependence on oncogenic B cell signaling pathways. Significantly, CVA21 also activated natural killer (NK) cells to kill neoplastic B cells and drug-resistant B cells remained susceptible to NK cell-mediated lysis. Overall, these data reveal a dual mode of action of CVA21 against drug-resistant B cells and support the development of CVA21 for the treatment of B cell neoplasms.

Reovirus-induced cell-mediated immunity for the treatment of multiple myeloma within the resistant bone marrow niche

BACKGROUND

Multiple myeloma (MM) remains an incurable disease and oncolytic viruses offer a well-tolerated addition to the therapeutic arsenal. Oncolytic reovirus has progressed to phase I clinical trials and its direct lytic potential has been extensively studied. However, to date, the role for reovirus-induced immunotherapy against MM, and the impact of the bone marrow (BM) niche, have not been reported.

METHODS

This study used human peripheral blood mononuclear cells from healthy donors and in vitro co-culture of MM cells and BM stromal cells to recapitulate the resistant BM niche. Additionally, the 5TGM1-Kalw/RijHSD immunocompetent in vivo model was used to examine reovirus efficacy and characterize reovirus-induced immune responses in the BM and spleen following intravenous administration. Collectively, these in vitro and in vivo models were used to characterize the development of innate and adaptive antimyeloma immunity following reovirus treatment.

RESULTS

Using the 5TGM1-Kalw/RijHSD immunocompetent in vivo model we have demonstrated that reovirus reduces both MM tumor burden and myeloma-induced bone disease. Furthermore, detailed immune characterization revealed that reovirus: (i) increased natural killer (NK) cell and CD8+ T cell numbers; (ii) activated NK cells and CD8+ T cells and (iii) upregulated effector-memory CD8+ T cells. Moreover, increased effector-memory CD8+ T cells correlated with decreased tumor burden. Next, we explored the potential for reovirus-induced immunotherapy using human co-culture models to mimic the myeloma-supportive BM niche. MM cells co-cultured with BM stromal cells displayed resistance to reovirus-induced oncolysis and bystander cytokine-killing but remained susceptible to killing by reovirus-activated NK cells and MM-specific cytotoxic T lymphocytes.

CONCLUSION

These data highlight the importance of reovirus-induced immunotherapy for targeting MM cells within the BM niche and suggest that combination with agents which boost antitumor immune responses should be a priority.

Plasmacytoid dendritic cells orchestrate innate and adaptive anti-tumor immunity induced by oncolytic coxsackievirus A21

BACKGROUND

The oncolytic virus, coxsackievirus A21 (CVA21), has shown promise as a single agent in several clinical trials and is now being tested in combination with immune checkpoint blockade. Combination therapies offer the best chance of disease control; however, the design of successful combination strategies requires a deeper understanding of the mechanisms underpinning CVA21 efficacy, in particular, the role of CVA21 anti-tumor immunity. Therefore, this study aimed to examine the ability of CVA21 to induce human anti-tumor immunity, and identify the cellular mechanism responsible.

METHODS

This study utilized peripheral blood mononuclear cells from i) healthy donors, ii) Acute Myeloid Leukemia (AML) patients, and iii) patients taking part in the STORM clinical trial, who received intravenous CVA21; patients receiving intravenous CVA21 were consented separately in accordance with local institutional ethics review and approval. Collectively, these blood samples were used to characterize the development of innate and adaptive anti-tumor immune responses following CVA21 treatment.

RESULTS

An Initial characterization of peripheral blood mononuclear cells, collected from cancer patients following intravenous infusion of CVA21, confirmed that CVA21 activated immune effector cells in patients. Next, using hematological disease models which were sensitive (Multiple Myeloma; MM) or resistant (AML) to CVA21-direct oncolysis, we demonstrated that CVA21 stimulated potent anti-tumor immune responses, including: 1) cytokine-mediated bystander killing; 2) enhanced natural killer cell-mediated cellular cytotoxicity; and 3) priming of tumor-specific cytotoxic T lymphocytes, with specificity towards known tumor-associated antigens. Importantly, immune-mediated killing of both MM and AML, despite AML cells being resistant to CVA21-direct oncolysis, was observed. Upon further examination of the cellular mechanisms responsible for CVA21-induced anti-tumor immunity we have identified the importance of type I IFN for NK cell activation, and demonstrated that both ICAM-1 and plasmacytoid dendritic cells were key mediators of this response.

CONCLUSION

This work supports the development of CVA21 as an immunotherapeutic agent for the treatment of both AML and MM. Additionally, the data presented provides an important insight into the mechanisms of CVA21-mediated immunotherapy to aid the development of clinical biomarkers to predict response and rationalize future drug combinations.

Potentiating Oncolytic Virus-Induced Immune-Mediated Tumor Cell Killing Using Histone Deacetylase Inhibition

A clinical oncolytic herpes simplex virus (HSV) encoding granulocyte-macrophage colony-stimulating factor (GM-CSF), talimogene laherparepvec, causes regression of injected and non-injected melanoma lesions in patients and is now licensed for clinical use in advanced melanoma. To date, limited data are available regarding the mechanisms of human anti-tumor immune priming, an improved understanding of which could inform the development of future combination strategies with improved efficacy. This study addressed direct oncolysis and innate and adaptive human immune-mediated effects of a closely related HSV encoding GM-CSF (HSVGM-CSF) alone and in combination with histone deacetylase inhibition. We found that HSVGM-CSF supported activation of anti-melanoma immunity via monocyte-mediated type I interferon production, which activates NK cells, and viral maturation of immature dendritic cells (iDCs) into potent antigen-presenting cells for cytotoxic T lymphocyte (CTL) priming. Addition of the histone deacetylase inhibitor valproic acid (VPA) to HSVGM-CSF treatment of tumor cells increased viral replication, viral GM-CSF production, and oncolysis and augmented the development of anti-tumor immunity. Mechanistically, VPA increased expression of activating ligands for NK cell recognition and induced expression of tumor-associated antigens, supporting innate NK cell killing and CTL priming. These data support the clinical combination of talimogene laherparepvec with histone deacetylase inhibition to enhance oncolysis and anti-tumor immunity.

Abstract 20: Oncolytic virotherapy enhances Smac mimetic treatment of acute myeloid leukemia

This study demonstrates that the combination of Smac mimetic and oncolytic virotherapy (OVT) induces cell death in acute myeloid leukemia (AML) cell lines and primary patient samples; this is the first time the efficacy of this combination approach has been investigated in a human cancer model and for the treatment of AML.

Methods: The Smac mimetic LCL161 and several oncolytic viruses (OVs) were tested for in vitro cytotoxicity against a panel of diverse AML cell lines. Bystander killing of LCL161-treated AML cells was explored using conditioned media from OV-treated PBMCs. Multiplex immunoassays were used to detect potential mediators of bystander cytotoxicity produced following OV treatment. Several upregulated cytokines were tested for their ability to enhance LCL161 toxicity in AML cell lines by MTS assay. The activation of healthy donor peripheral blood mononuclear cells (PBMC) was investigated by flow cytometry and immune cell-mediated death of AML cells was measured using chromium release assays. In vitro direct and bystander toxicity was further verified using fresh blood samples from AML patients.

Results: A rhabdovirus, MG1, showed the greatest cytotoxicity across a panel of AML cell lines compared to several other OVs. In resistant cell lines the addition of LCL161 treatment led to increased cell death, indicating the potential merits of a combination strategy. Primary AML samples exposed to both LCL161 and MG1 showed greater levels of cell death than either treatment alone, confirming combinational efficacy. Treating healthy donor PBMCs with virus induced the activation of innate immune effector cells, as indicated by an increase in CD69 on NK cells as well as stimulating CD14+ monocytes to produce membrane-bound TNFα-related apoptosis-inducing ligand (TRAIL). Immune cell-mediated death was increased following activation by MG1, and LCL161 sensitized AML cell lines to death by the membrane mimicking KillerTRAIL. Conditioned media from MG1-treated healthy and patient-derived PBMCs displayed an inflammatory milieu that was toxic to AML cell lines. Further analysis identified several cytokines relevant to AML therapy, including the anti-viral interferon alpha (IFNα), soluble TRAIL, and tumor necrosis factor alpha (TNFα); LCL161 was able to increase the sensitivity of AML cells to MG1-conditioned media and recombinant versions of IFNα and TNFα.

Discussion: OVT has shown positive clinical efficacy in many solid tumors; however, it is underexplored in the context of hematologic malignancies. Many cases of spontaneous remission following viral infection, the correlation of cytomegalovirus reactivation and positive prognosis following hematologic stem cell transplant, along with the identification of OVs which target leukemic cells without harming healthy hematologic stem cells, suggest that AML patients may be suitable for OVT. Indeed, data from our lab suggest that PBMCs from AML patients are able to recognize and respond to OV, to induce antitumor cytotoxicity. MG1 is cytotoxic to AML cells and acts as an immunogenic agent to induce the release of soluble inflammatory mediators by PBMCs that lead to the death of bystander cells without the need for direct infection. Recent studies into the use of Smac mimetics in hematologic malignancies have demonstrated the synergistic action of combining treatment with inflammatory cytokines, suggesting that combination with an immunogenic agent may be beneficial. Indeed, LCL161 is able to sensitize both AML cell lines and patient-derived AML blasts to MG1 treatment. The release of inflammatory mediators following MG1 treatment also stimulates the activation of innate immune effector cells to induce AML cell death, indicating the ability to initiate a cell-mediated innate immune attack on AML cells using this regime. In conclusion, these data suggest that MG1 should be considered in combination with the Smac mimetic, LCL161, for the treatment of AML.

Citation Format: Joanne L. Hopper, Louise ME Müller, Victoria A. Jennings, Gina B. Scott, Stewart McConnell, Richard Kelly, Fiona Errington-Mais. Oncolytic virotherapy enhances Smac mimetic treatment of acute myeloid leukemia [abstract]. In: Proceedings of the Second AACR Conference on Hematologic Malignancies: Translating Discoveries to Novel Therapies; May 6-9, 2017; Boston, MA. Philadelphia (PA): AACR; Clin Cancer Res 2017;23(24_Suppl):Abstract nr 20.

Abstract 18: Evaluating the contribution of anti-myeloma immunity for the efficacy of oncolytic reovirus therapy

Introduction: The aim of this study was to examine the contribution of antitumor immunity for the efficacy of oncolytic reovirus therapy against multiple myeloma (MM). Oncolytic viruses (OV) have two main mechanisms of action; direct lytic killing and potentiation of antitumor immunity. The direct oncolytic potential of reovirus in MM has previously been demonstrated both in vitro and in vivo, but the importance of an enhanced immunologic antitumor response remains underinvestigated. Reovirus-induced antitumor immunity has been demonstrated in other types of cancer such as melanoma and chronic leukemia, and is of major importance for the efficacy of OV treatment. Thus, it was hypothesized that reovirus-induced antimyeloma immunity would contribute significantly to the efficacy of reovirus treatment for MM.

Experimental Procedures: C57BL/KaLwRij mice were used in the 5TGM1 model system to establish MM in vivo. This model closely resembles human MM with induction of osteolytic bone disease and secretion of paraprotein. C57BL/KaLwRij mice have a fully functional immune system, comparable to C57BL/6 mice, and to our knowledge, this is the first immunocompetent model of MM for the study of reovirus efficacy. After establishment of MM in the bone by intravenous injection of bone-homing 5TGM1 cells, mice were treated with repeated injections of reovirus or PBS. Upon sacrifice, direct cytotoxicity and immune activation was examined using flow cytometry. All animal experiments were performed under an appropriate project license following approval by a local ethical review committee. In vivo findings were translated into human in vitro studies, using MM cell lines, healthy donor (HD) blood, and MM patient samples. Reovirus-induced Natural Killer (NK) cell activation and degranulation was examined using flow cytometry and priming of myeloma-specific T cells was performed using long-term priming cultures.

Results: Tumor burden was reduced by reovirus treatment both in the bone marrow (BM) and spleen of tumor-bearing mice. The immune cell populations, including NK cells, CD4+ T cells, and CD8+ T cells, were restored to levels of tumor-naïve mice in the BM. NK cells were activated in the BM following reovirus treatment, which indicates the onset of an innate immune response. In the spleen, an increase in CD4+ T cells, in combination with CD8+ activation, was indicative of an early adaptive immune response. These results translate into human in vitro findings, using both HD and MM patient samples, with activation of NK cells in response to reovirus treatment and subsequent enhancement of NK cell degranulation and killing of MM target cells. Encouragingly, reovirus-activated NK cells were able to kill OPM2 cells, which are resistant to direct lytic killing. Preliminary human in vitro studies suggest that reovirus treatment can prime antimyeloma CD8+ T cells for the induction of a long-term protective response.

Conclusions: Introducing a viral agent into the body requires a delicate immunologic balance to avoid neutralizing the virus by an antiviral response and simultaneously allowing the enhancement of antitumor immunity. The importance of enhanced antitumor immunity for OV therapy efficacy is becoming more widely recognized and antiviral immunity can in some circumstances contribute to tumor eradication. The findings in this study indicate that the antitumor immune response is also important in the MM setting, with activation of both innate and adaptive immune responses resulting in enhanced killing of MM cells, in particular those resistant to direct lytic killing. This suggests that both arms of OV therapy could play a role for MM eradication, including any minimal residual disease. Future work will explore whether the antimyeloma response can be further enhanced by combinatorial treatments, including current standard of care treatments.

Citation Format: Louise M. E. Müller, Christopher Parrish, Gemma Migneco, Gina B. Scott, Matthew Holmes, Alan A. Melcher, Michelle A. Lawson, Gordon Cook, Fiona Errington-Mais. Evaluating the contribution of anti-myeloma immunity for the efficacy of oncolytic reovirus therapy [abstract]. In: Proceedings of the Second AACR Conference on Hematologic Malignancies: Translating Discoveries to Novel Therapies; May 6-9, 2017; Boston, MA. Philadelphia (PA): AACR; Clin Cancer Res 2017;23(24_Suppl):Abstract nr 18.

Downregulation of myeloma-induced ICOS-L and regulatory T cell generation by lenalidomide and dexamethasone therapy

Multiple myeloma (MM) produces significant cellular and humoral immune defects. We have previously reported that MM induces CD4(+)CD25(+)FoxP3(+) cells (TRegs), via tumour expression of the immune checkpoint regulator, ICOS-L. We sought to define what impact the immunomodulatory drug lenalidomide, alone or with dexamethasone, has on TReg cell generation. Lenalidomide pre-treatment of MM cell lines reduced TReg generation and the concomitant TReg:TEff (CD4(+)CD25(+)FoxP3(-): effector T cells) ratio, as a consequence of reduced ICOSL transcription. Dexamethasone did not affect surface ICOS-L expression but did induce TReg cell apoptosis without impacting on TEff cell survival. Combined lenalidomide and dexamethasone significantly reduced both TReg induction and the TReg:TEff cell ratio. In vivo, serial analysis of the TReg:TEff ratio in MM patients on lenalidomide-dexamethasone therapy revealed a progressive reduction towards age-matched control values, though not complete correction. Our data demonstrate for the first time immune synergism to explain the observed immune-modulation associated with lenalidomide-dexamethasone therapy.

Controlled infection with a therapeutic virus defines the activation kinetics of human natural killer cells in vivo

Human natural killer (NK) cells play an important role in anti-viral immunity. However, studying their activation kinetics during infection is highly problematic. A clinical trial of a therapeutic virus provided an opportunity to study human NK cell activation in vivo in a controlled manner. Ten colorectal cancer patients with liver metastases received between one and five doses of oncolytic reovirus prior to surgical resection of their tumour. NK cell surface expression of the interferon-inducible molecules CD69 and tetherin peaked 24-48 h post-infection, coincident with a peak of interferon-induced gene expression. The interferon response and NK cell activation were transient, declining by 96 h post-infection. Furthermore, neither NK cell activation nor the interferon response were sustained in patients undergoing multiple rounds of virus treatment. These results show that reovirus modulates human NK cell activity in vivo and suggest that this may contribute to any therapeutic effect of this oncolytic virus. Detection of a single, transient peak of activation, despite multiple treatment rounds, has implications for the design of reovirus-based therapy. Furthermore, our results suggest the existence of a post-infection refractory period when the interferon response and NK cell activation are blunted. This refractory period has been observed previously in animal models and may underlie the enhanced susceptibility to secondary infections that is seen following viral infection.

Epithelial cell ADAM17 activation by Helicobacter pylori: role of ADAM17 C-terminus and Threonine-735 phosphorylation

Helicobacter pylori transactivates the epidermal growth factor receptor (EGFR) on gastric epithelial cells via a signalling cascade involving a disintegrin and metalloprotease 17 (ADAM17) cleavage of membrane bound heparin binding-epidermal growth factor (HB-EGF). The effects of H. pylori on ADAM17 C-terminus in epithelial cells have been examined. Total cellular ADAM17 and surface expression of ADAM17 were significantly increased by H. pylori in AGS gastric epithelial cells. These changes were associated with ADAM17 C-terminal phosphorylation at T375 and S791. AGS cells lacking the ADAM17 C-terminal domain induced significantly attenuated cleavage of HB-EGF and were also unable to upregulate HB-EGF and EGFR transcripts to the same extent as cells expressing full length ADAM17. In mitotic unstimulated AGS and ADAM17 over-expressing AGS cells, ADAM17 was highly T735 phosphorylated indicating ADAM17 T735 phosphorylation is modified during the cell cycle. In conclusion, H. pylori induced ADAM17 C-terminal T735 and/or S791 phosphorylation in gastric epithelial cells are likely to be an important trigger inducing ADAM17 activation and shedding of HB-EGF leading to EGFR transactivation. ADAM17 over-expression in gastric cancer represents a potential target for therapeutic intervention.

Blocking oncogenic RAS enhances tumour cell surface MHC class I expression but does not alter susceptibility to cytotoxic lymphocytes

Mutations in the RAS family of oncogenes are highly prevalent in human cancer and, amongst its manifold effects, oncogenic RAS impairs the expression of components of the antigen presentation pathway. This allows evasion of cytotoxic T lymphocytes (CTL). CTL and natural killer (NK) cells are reciprocally regulated by MHC class I molecules and any gain in CTL recognition obtained by therapeutic inactivation of oncogenic RAS may be offset by reduced NK cell activation. We have investigated the consequences of targeted inactivation of oncogenic RAS on the recognition by both CTL and NK cells. Inactivation of oncogenic RAS, either by genetic deletion or inactivation with an inducible intracellular domain antibody (iDAb), increased MHC class I expression in human colorectal cell lines. The common RAS mutations, at codons 12, 13 and 61, all inhibited antigen presentation. Although MHC class I modulates the activity of both CTL and NK cells, the enhanced MHC class I expression resulting from inactivation of mutant KRAS did not significantly affect the in vitro recognition of these cell lines by either class of cytotoxic lymphocyte. These results show that oncogenic RAS and its downstream signalling pathways modulate the antigen presentation pathway and that this inhibition is reversible. However, the magnitude of these effects was not sufficient to alter the in vitro recognition of tumour cell lines by either CTL or NK cells.

Immune dysfunction in multiple myeloma

SUMMARY Although there have been advances in the field, multiple myeloma, the second most common hematological malignancy, remains an incurable disease characterized by ever-shortening cycles of treatment and relapse. Myriad experimental and observational studies over the last few decades have comprehensively documented a state of profound immune dysfunction, which is progressive and correlated with disease stage. Nonetheless, immune responses against the tumor have demonstrated efficacy ex vivo, in animal models and in human disease. In this review we examine the immune defects in multiple myeloma and consider current and future approaches toward correction and manipulation of immune responses to affect clinically useful antitumor effects.

Tumour cell generation of inducible regulatory T-cells in multiple myeloma is contact-dependent and antigen-presenting cell-independent

Regulatory T-cells (T_Reg cells) are increased in patients with multiple myeloma (MM). We investigated whether MM cells could generate and/or expand T_Reg cells as a method of immuno-surveillance avoidance. In an in vitro model, CD4⁺CD25^-FoxP3^- T-cells co-cultured with malignant plasma cells (primary MM cells and cell lines) induced a significant generation of CD4⁺CD25⁺FoxP3⁺ inducible T_Reg cells (tT_Reg cells; p<0.0001), in a contact-dependent manner. tT_Reg cells were polyclonal, demonstrated a suppressive phenotype and phenotypically, demonstrated increased FoxP3 (p = 0.0001), increased GITR (p<0.0001), increased PD1 (p = 0.003) and decreased CD62L (p = 0.007) expression compared with naturally occurring T_Reg cells. FACS-sorted tT_Reg cells differentiated into FoxP⁺IL-17⁺ and FoxP3^-IL-17⁺ CD4⁺ cells upon TCR-mediated stimulation. Blocking experiments with anti-ICOS-L MoAb resulted in a significant inhibition of tT_Reg cell generation whereas both IL-10 & TGFβ blockade did not. MM tumour cells can directly generate functional T_Reg cells in a contact-dependent manner, mediated by ICOS/ICOS-L. These features suggest that tumour generation of T_Reg cells may contribute to evasion of immune surveillance by the host.

Functional assays to determine the significance of two common XPC 3'UTR variants found in bladder cancer patients

BACKGROUND

XPC is involved in the nucleotide excision repair of DNA damaged by carcinogens known to cause bladder cancer. Individuals homozygous for the variant allele of XPC c.1496C > T (p.Ala499Val) were shown in a large pooled analysis to have an increased bladder cancer risk, and we found two 3'UTR variants, *611T > A and c.*618A > G, to be in strong linkage disequilibrium with c.1496T. Here we determined if these two 3'UTR variants can affect mRNA stability and assessed the impact of all three variants on mRNA and protein expression.

METHODS

In vitro mRNA stability assays were performed and mRNA and protein expression measured both in plasmid-based assays and in lymphocytes and lymphoblastoid cell lines from bladder and breast cancer patients.

RESULTS

The two 3'UTR variants were associated with reduced protein and mRNA expression in plasmid-based assays, suggesting an effect on mRNA stability and/or transcription/translation. A near-significant reduction in XPC protein expression (p = 0.058) was detected in lymphoblastoid cell lines homozygous for these alleles but no differences in mRNA stability in these lines was found or in mRNA or protein levels in lymphocytes heterozygous for these alleles.

CONCLUSION

The two 3'UTR variants may be the variants underlying the association of c.1496C > T and bladder cancer risk acting via a mechanism modulating protein expression.

In vitro functional effects of XPC gene rare variants from bladder cancer patients

The XPC gene is involved in repair of bulky DNA adducts formed by carcinogenic metabolites and oxidative DNA damage, both known bladder cancer risk factors. Single nucleotide polymorphisms (SNPs) in XPC have been associated with increased bladder cancer risk. Recently, rarer genetic variants have been identified but it is difficult to ascertain which are of functional importance. During a mutation screen of XPC in DNA from 33 bladder tumour samples and matched blood samples, we identified five novel variants in the patients' germ line DNA. In a case-control study of 771 bladder cancer cases and 800 controls, c.905T>C (Phe302Ser), c.1177C>T (Arg393Trp), c.*156G>A [3' untranslated region (UTR)] and c.2251-37C>A (in an intronic C>G SNP site) were found to be rare variants, with a combined odds ratio of 3.1 (95% confidence interval 1.0-9.8, P=0.048) for carriage of one variant. The fifth variant was a 2% minor allele frequency SNP not associated with bladder cancer. The two non-synonymous coding variants were predicted to have functional effects using analytical algorithms; a reduced recruitment of GFP-tagged XPC plasmids containing either c.905T>C or c.1177C>T to sites of 408 nm wavelength laser-induced oxidative DNA damage was found in vitro. c.*156G>A appeared to be associated with reduced messenger RNA stability in an in vitro plasmid-based assay. Although the laser microbeam assay is relevant to a range of DNA repair genes, our 3' UTR assay based on Green fluorescent protein(GFP) has widespread applicability and could be used to assess any gene. These assays may be useful in determining which rare variants are functional, prior to large genotyping efforts.

Detecting variable (V), diversity (D) and joining (J) gene segment recombination using a two-colour fluorescence system

Background

Diversity of immunoglobulins and the T cell antigen receptors is achieved via the recombination activating gene (RAG)-mediated rearrangement of variable (V), diversity (D) and joining (J) gene segments, and this underpins the efficient recognition of a seemingly limitless array of antigens. Analysis of V(D)J recombination activity is typically performed using extrachromosomal recombination substrates that are recovered from transfected cells and selected using bacterial transformation. We have developed a two-colour fluorescence-based system that simplifies detection of both deletion and inversion joining events mediated by RAG proteins.

Results

This system employs two fluorescent reporter genes that differentially mark unrearranged substrates and those that have undergone RAG-mediated deletion or inversion events. The recombination products bear the hallmarks of true V(D)J recombination and activity can be detected using fluorescence microscopy or flow cytometry. Recombination events can be detected without the need for cytotoxic selection of recombination products and the system allows analysis of recombination activity using substrates integrated into the genome.

Conclusions

This system will be useful in the analysis and exploitation of the V(D)J recombination machinery and suggests that similar approaches could be used to replace expression of one gene with another during lymphocyte development.

Profiling killers; unravelling the pathways of human natural killer cell function

Natural killer (NK) cells are lymphocytes with an innate ability to recognize and kill infected cells and tumour cells. Unlike B and T cells, NK cells do not express an antigen receptor. Instead, NK cells detect changes in the phenotype of the target cell surface; malignant transformation or infection resulting in the loss or gain of particular molecules that are detected by inhibitory or activating receptors on the NK cell surface. The identification and characterization of NK cells and their receptors was made possible by monoclonal antibody technology. The ease with which genes and gene products can now be identified and manipulated has accelerated our understanding of NK cell function. Furthermore, gene and protein profiling studies are beginning to refine our understanding of NK cells, their interactions with other cells and their effector mechanisms. This review illustrates some of the basic features of NK cell biology and highlights the contribution made by post-genomic technology in defining the molecular mechanisms by which NK cells identify and kill susceptible targets.

Potassium diazoacetate-induced p53 mutations in vitro in relation to formation of O6-carboxymethyl- and O6-methyl-2'-deoxyguanosine DNA adducts: relevance for gastrointestinal cancer

Nitrosated glycine derivatives react with DNA to form O6-carboxymethyl-2'-deoxyguanosine (O6-CMdG) and O6-methyl-2'-deoxyguanosine (O6-MedG) adducts concurrently. O6-CMdG is not repaired by O6-alkylguanine alkyltransferases and might be expected to lead to mutations via a similar mechanism to O6-MedG. Potassium diazoacetate (KDA) is a stable form of nitrosated glycine and its ability to induce mutations in the p53 gene in a functional yeast assay was studied. Treatment of a plasmid containing the human p53 cDNA sequence with KDA afforded readily detectable levels of O6-CMdG and O6-MedG. The treated plasmid was used to transform yeast cells and coloured colonies harbouring a p53 sequence with functional mutations were detected. Recovery of the mutated plasmids followed by DNA sequencing enabled the mutation spectrum of KDA to be characterised. The most common mutations induced by KDA were substitutions with >50% occurring at GC base pairs. In contrast to the methylating agent methylnitrosourea which gives predominantly (>80%) GC-->AT transitions, KDA produced almost equal amounts of transitions (GC-->AT) and transversions (GC-->TA and AT-->TA). This difference is probably due to a different mode of base mispairing for O6-CMdG compared with O6-MedG. The pattern of mutations induced by KDA was very similar to the patterns observed in mutated p53 in human gastrointestinal tract tumours. These results are consistent with the hypothesis that nitrosation of glycine (or glycine derivatives) may contribute to characteristic human p53 mutation profiles. This conclusion is borne out by recent observations that O6-CMdG is present in human DNA both from blood and exfoliated colorectal cells and is consistent with recent epidemiological studies that have concluded that endogenous nitrosation arising from red meat consumption is related to an increased risk of colorectal cancer.

Hemispheric asymmetry for word naming: effects of frequency and regularity of pronunciation

Observers named visually presented words as quickly as possible when the words were presented to the centre of a viewing screen (Experiments 1, 5, and 6) or were flashed to either the left visual field/right hemisphere (LVF/RH) or right visual field/left hemisphere (RVF/LH) on each trial (Experiments, 2, 3, and 4). Words varied in frequency of occurrence in the language and in regularity of pronunciation. On lateralised trials, there was a RVF/LH advantage for both error rate and reaction time, with this hemispheric asymmetry for word naming being independent of both frequency and regularity. The RVF/LH advantage was also independent of whether the letters within a word were arranged horizontally or vertically. Error rates and reaction times were lower for high-than for low-frequency words and lower for words with a regular pronunciation than for exception words. In addition, on centre trials the effects of regularity were larger for low-frequency words than for high-frequency words. However, when words were presented in the visual periphery, the effects of regularity were of the same magnitude for high-and low-frequency words. In view of the theoretical importance of the Frequency by Regularity interaction, this latter result suggests that word processing is qualitatively different in the visual periphery than in the centre of vision; indicating that perceptual asymmetries in a typical visual half-field experiment may be limited in what they can tell us about the relative contributions of the two hemispheres to processing words in the centre of vision.

UCH-L1 aggresome formation in response to proteasome impairment indicates a role in inclusion formation in Parkinson's disease

Aggresomes are associated with many neurodegenerative disorders, including Parkinson's disease, and polyglutamine disorders such as Huntington's disease. These inclusions commonly contain ubiquitylated proteins. The stage at which these proteins are ubiquitylated remains unclear. A malfunction of the ubiquitin/proteasome system (UPS) may be associated with their formation. Conversely, it may reflect an unsuccessful attempt by the cell to remove them. Previously, we demonstrated that overexpression of Parkin, a ubiquitin-protein ligase associated with autosomal recessive juvenile Parkinsonism, generates aggresome-like inclusions in UPS compromised cells. Mutations in the de-ubiquitylating enzyme, UCH-L1, cause a rare form of Parkinsonism. We now demonstrate that overexpression of UCH-L1 also forms ribbon-like aggresomes in response to proteasomal inhibition. Disease-associated mutations, which affect enzymatic activities, significantly increased the number of inclusions. UCH-L1 aggresomes co-localized with ubiquitylated proteins, HSP70, gamma-tubulin and, to a lesser extent, the 20S proteasome and the chaperone BiP. Similar to Parkin inclusions, we found UCH-L1 aggresomes to be surrounded by a tubulin rather than a vimentin cage-like structure. Furthermore, UCH-L1 aggregates with Parkin and alpha-synuclein in some, but not all inclusions, suggesting the heterogeneous nature of these inclusion bodies. This study provides additional evidence that aggregation-prone proteins are likely to recruit UPS components in an attempt to clear proteins from failing proteasomes. Furthermore, UCH-L1 accumulation is likely to play a pathological role in inclusion formation in Parkinson's disease.

Inhibition of proteasomal activity causes inclusion formation in neuronal and non-neuronal cells overexpressing Parkin

Association between protein inclusions and neurodegenerative diseases, including Parkinson's and Alzheimer's diseases, and polyglutamine disorders, has been widely documented. Although ubiquitin is conjugated to many of these aggregated proteins, the 26S proteasome does not efficiently degrade them. Mutations in the ubiquitin-protein ligase Parkin are associated with autosomal recessive juvenile Parkinsonism. Although Parkin-positive inclusions are not detected in brains of autosomal recessive juvenile Parkinsonism patients, Parkin is found in Lewy bodies in sporadic disease. This suggests that loss of Parkin ligase activity via mutation, or sequestration to Lewy bodies, is a contributory factor to sporadic disease onset. We now demonstrate that decreased proteasomal activity causes formation of large, noncytotoxic inclusions within the cytoplasm of both neuronal and nonneuronal cells overexpressing Parkin. This is not a general phenomenon as there is an absence of similar inclusions when HHARI, a structural homolog of Parkin, is overexpressed. The inclusions colocalize with ubiquitin and with proteasomes. Furthermore, Parkin inclusions colocalize with gamma-tubulin, acetylated alpha-tubulin, and cause redistribution of vimentin, suggesting aggresome-like properties. Our data imply that lower proteasomal activity, previously observed in brain tissue of Parkinson's disease patients, leads to Parkin accumulation and a concomitant reduction in ligase activity, thereby promoting Lewy body formation.

Human homologue of ariadne promotes the ubiquitylation of translation initiation factor 4E homologous protein, 4EHP

Human homologue of Drosophila ariadne (HHARI) is a RING-IBR-RING domain protein identified through its ability to bind the human ubiquitin-conjugating enzyme, UbcH7. We now demonstrate that HHARI also interacts with the eukaryotic mRNA cap binding protein, translation initiation factor 4E homologous protein (4EHP), via the N-terminal RING1 finger of HHARI. HHARI, 4EHP and UbcH7 do not form a stable heterotrimeric complex as 4EHP cannot immunoprecipitate UbcH7 even in the presence of HHARI. Overexpression of 4EHP and HHARI in mammalian cells leads to polyubiquitylation of 4EHP. By contrast, HHARI does not promote its own autoubiquitylation. Thus, by promoting the ubiquitin-mediated degradation of 4EHP, HHARI may have a role in both protein degradation and protein translation.

Functional and structural defects in HIV type 1 nef genes derived from pediatric long-term survivors

DNA sequences and three distinct in vitro functions of Nef were evaluated in a group of seven perinatally infected children. nef gene sequences obtained before and after virus culture showed that one of the five non-/slow progressors harbored a virus with large deletions. nef genes from the remaining four children were full length but contained discrete changes at a higher frequency than the rapid progressors. In functional studies, 40 of 44 Nef proteins derived from the whole study group were capable of binding the cellular serine kinase p62, indicating that this function is well conserved among naturally occurring viruses. In contrast, representative Nef proteins derived from the long-term non-/slow progressors were found to be defective or far less capable of enhancing viral replication and/or viral infectivity in herpesvirus saimiri-transformed human T cells and peripheral blood mononuclear cells. On reversion of highly prevalent point mutations in the defective proteins, viral replication could be restored to wild-type levels. Our results suggest that nef genes derived from pediatric long-term nonprogressors have gross deletions in isolated cases but a higher prevalence of discrete changes that may impair Nef function in primary T cell assays, but not all functions reported for Nef.

HIV-infected parents and their children in the United States

OBJECTIVES

This study sought to determine the number, characteristics, and living situations of children of HIV-infected adults.

METHODS

Interviews were conducted in 1996 and early 1997 with a nationally representative probability sample of 2864 adults receiving health care for HIV within the contiguous United States.

RESULTS

Twenty-eight percent of infected adults in care had children. Women were more likely than men to have children (60% vs 18%) and to live with them (76% vs 34%). Twenty-one percent of parents had been hospitalized during the previous 6 months, and 10% had probably been drug dependent in the previous year. Parents continued to have children after being diagnosed with HIV: 12% of all women conceived and bore their youngest child after diagnosis, and another 10% conceived before but gave birth after diagnosis.

CONCLUSIONS

Clinical and support services for people affected by the HIV epidemic should have a family focus.

Effect of prenatal zidovudine on disease progression in perinatally HIV-1-infected infants

OBJECTIVE

To determine the influence of prenatal zidovudine (ZDV) prophylaxis on the course of HIV- 1 infection in children by comparing the clinical outcome of infants born to HIV- 1-seropositive mothers who did versus those who did not receive ZDV during pregnancy.

METHODS

Medical records of HIV-1-seropositive mothers and their infants were reviewed retrospectively. Participants were divided according to maternal ZDV use: no ZDV (n = 152); ZDV (n = 139). The main outcome measure was rapid disease progression (RPD) in the infant, defined as occurrence of a category C disease or AIDS-related death before 18 months of age.

RESULTS

HIV vertical transmission rates were significantly different (no ZDV versus ZDV: 22.3% versus 12.2%; p = .034). Among infected infants, the RPD rate was 29.4% in the no ZDV group compared with 70.6% in the ZDV group (p = .012), and prematurity was significantly associated with a higher risk of RPD (p = .027).

CONCLUSIONS

The rate of RPD was significantly higher among perinatally infected infants born to HIV-infected mothers treated with ZDV than among infected infants born to untreated mothers. The decreased proportion of infected infants with nonrapid disease progression in the former group might be related to the ability of ZDV to block intrapartum transmission preferentially and also to nonrapid disease progression resulting from intrapartum transmission.

Gram-negative bacillary bacteremia in human immunodeficiency virus type 1-infected children

BACKGROUND

HIV-infected children are particularly susceptible to serious bacterial infections including Gram-negative bacillary bacteremia (GNB). However, the information available on GNB in these children is limited.

METHODS

Retrospective review of hospital charts of HIV-infected children with GNB diagnosed between 1980 and 1997. The association between bacteremic episodes, degree of immunosuppression, HIV severity, medical treatment and clinical outcome was assessed.

RESULTS

Of 680 HIV-infected children, 72 (10.6%) had 95 episodes of GNB. Statistical analyses were restricted to data from the first episode. The mean age (+/-SD) at diagnosis of GNB was 2.5 +/- 2.7 years (median, 1.6). The predominant organisms were Pseudomonas aeruginosa (26.4%), nontyphoidal Salmonella (15.3%), Escherichia coli (15.3%) and Haemophilus influenzae (12.5%). The relative frequency, per 5-year interval, of P. aeruginosa bacteremia steadily increased from 13% during 1980 through 1984 to 56% during 1995 through 1997. There were no cases of H. influenzae bacteremia after January 1, 1990. Eighty percent of GNB developed in children with AIDS and 72.2% developed in those with severe immunosuppression. Hypogamma-globulinemia and neutropenia were present in only 4.9 and 10.4% of first episodes, respectively. The overall case-fatality rate of GNB was 43.0%, and in children younger than 12 months it was 54.2%.

CONCLUSIONS

A diagnosis of AIDS and/or severe immunosuppression was associated with increased risk of GNB, especially among younger children. Because of the high mortality of GNB, a broad spectrum antimicrobial therapy that effectively covers these organisms should be promptly instituted when bacteremia is suspected in HIV-infected children.

Medical management of HIV disease in children

Significant advances have been made in the understanding of the pathophysiology of HIV infection since the beginning of the epidemic. This knowledge has translated into the development of new therapies for HIV and opportunistic infections, laboratory advances in monitoring viral and immune status, and a better understanding of factors affecting patient outcome. Concomitantly, significant progress has been made in the medical management of children with HIV infection in the past 5 years. The number of children reported with AIDS in the United States is decreasing, and efforts are shifting from caring for children with advanced immunosuppression and severe opportunistic infections to early HAART, maintenance of the immune system, and prevention of opportunistic infections. Primary care physicians are now more involved and informed in the care of HIV-infected patients. Although published data are limited, physicians who have been working with this population have observed a dramatic improvement in the quality of life and length of survival of these patients. Unfortunately, this progress is not shared by developing countries where resources are minimal and antiretroviral agents are commonly unavailable. Although efforts to develop a vaccine to prevent HIV infection are ongoing, progress has been slow. Education and awareness continue to be the most powerful weapons against HIV.

Ability of laying hens to jump between perches: individual variation and the effects of perch separation and motivation on behaviour

1. This study investigated the ability and the behaviour of laying hens jumping between perches 2 different distances apart using hungry and satiated birds to determine whether behaviour and success were related to motivation. 2. Four groups of 10 birds (Lohmann brown) trained to jump from one perch to another were subjected 4 times to each of the experimental treatments (2 perches with a distance of either 50 or 150 cm between them) whilst either hungry or satiated, controlling for time of day and order of presentation. 3. The behaviour of each bird on the 1st perch was observed for a maximum of 2 min or until the bird jumped from the perch. The outcome of each jump, number of head movements and steps, incidence and duration of calling, and activity score were recorded. 4. The probability of birds jumping was less at the greater distance and was not affected significantly by other experimental factors. 5. Head movements were more frequent in birds which jumped, at the shorter distance, in motivated (hungry) birds and in the morning rather than the afternoon. 6. More stepping was performed by birds which jumped and at the shorter distance; there was no significant effect of motivation or time of day on stepping rate. 7. Birds called more at the greater distance and this was interpreted as indicative of frustration. 8. Subjective scores for activity were lower when perches were separated by the greater distance and when birds were satiated (less motivated) rather than hungry. 9. Agitated head movements and stepping activity thus occurred mainly when birds were motivated and on the point of jumping whereas calling was associated with an apparent inability or unwillingness to jump.

Mortality risk in selenium-deficient HIV-positive children

OBJECTIVE

To determine the independent contribution of specific nutritional factors on disease progression and survival in HIV-1-infected children.

POPULATION

HIV-infected children (N = 24), who were perinatally exposed to the virus and symptomatic, were recruited between October and December of 1990 from the Jackson Memorial Pediatric Immunology Clinic, Miami, Florida, and observed for 5 years.

METHODS

Immune status was measured by CD4 cell count; nutritional status was determined using serum albumin and plasma trace elements including iron, zinc, and selenium. Cox proportional hazards regression models were used to evaluate the relationship of these parameters to survival. Use of antiretroviral treatment was considered in the statistical model, and age at death was considered a parameter of disease progression.

RESULTS

Over the course of the study, 12 children died of HIV-related causes. The final Cox multivariate analysis indicated that, of the variables evaluated, only CD4 cell count below 200 (risk ratio [RR] = 7.05; 95% confidence interval [CI], 1.87-26.5); p = .004], and low levels of plasma selenium (RR = 5.96; 95% CI, 1.32-26.81; p = .02) were significantly and independently related to mortality. Among the children who died, those with low selenium levels (< or =85 microg/L), died at a younger age, suggesting more rapid disease progression.

CONCLUSIONS

In pediatric HIV-infection, low plasma level of selenium is an independent predictor of mortality, and appears to be associated with faster disease progression.

Planning for children whose parents are dying of HIV/AIDS. American Academy of Pediatrics. Committee on Pediatric AIDS, 1998-1999

Although the character of acquired immunodeficiency syndrome is changing into a chronic illness, it is estimated that by the end of this century, 80 000 children and adolescents in the United States will be orphaned by parental death caused by human immunodeficiency virus infection. Plans for these children need to be made to ensure not only a stable, consistent environment that provides love and nurturing, but also the medical and social interventions necessary to cope with the tragic loss. Pediatricians should become aware of local laws and community resources and initiate discussion early in the course of parental illness to facilitate planning for the future care and custody of the children. States need to adopt laws and regulations that provide flexible approaches to guardianship and placement of children orphaned by acquired immunodeficiency syndrome.

Association of antibody reactivity to ELDKWA, a glycoprotein 41 neutralization epitope, with disease progression in children perinatally infected with HIV type 1

The association between antibody reactivity to the neutralizing epitope ELDKWA in the transmembrane glycoprotein gp41 and disease progression was investigated in 29 children perinatally infected with HIV-1. Levels of antibody reactivity to this epitope, measured over time, were associated with absolute CD4+ lymphocyte numbers and disease status, and inversely associated with the levels of acid-dissociated p24 antigen in the plasma. Early virus isolates from 10 of 12 children with no detectable antibody reactivity to this epitope were sequenced. Only three contained sequences that differed from the consensus, indicating that this epitope is well conserved in this population. None of these three children developed antibodies to the autologous sequences, indicating that at least 80% of children with negative antibody reactivity to this epitope were true nonresponders. Together, these results indicate that the ELDKWA determinant could be an important component in the formulation of a vaccine or for immunotherapeutic approaches to HIV-1 infection.

The fear levels after transport of hens from cages and a free-range system

All end-of-lay hens must be transported from the production site to the site for slaughter, usually by road. The acts of being crated and transported are likely to be novel and potentially frightening. Frightened birds can be put into tonic immobility (TI), an unlearned, catatonic state, the duration of which is positively related to the fear level of the birds. Ninety ISA Brown free-range birds (in three groups of 30) and 90 caged ISA Brown birds (in similar groups) were transported (one group from cages and free-range per day) on a journey of 68 km (74 min approximately). On their return, each of the birds was subjected to TI. Although no significant differences were recorded between free-range and caged birds after they were transported (P = 0.087), in the comparison between the same birds after 7 wk, without transport, a significant difference in fear levels was observed (P < 0.001). The free-range birds were less frightened than the caged birds. No significant difference was ever found in fear levels for caged birds from different tiers. Handling and transport on this relatively short journey was apparently equally frightening for caged and free-range birds. It cannot be assumed that just because fear levels differ between free-range and caged birds, this difference will be apparent for all novel stimuli. If all birds, at all tiers, receive the same amount of human contact during the production period, there is no reason to expect differences to occur in fear levels of birds from different tiers.

Effects of output order on hemispheric asymmetry for processing letter trigrams

Observers identified consonant-vowel-consonant trigrams with the letters arranged vertically by pronouncing the stimulus (treating the bottom letter as the first letter) and spelling it from bottom to top. On each trial, the trigram was presented to the left visual field/right hemisphere (LVF/RH), to the right visual field/left hemisphere (RVF/LH), or to both visual fields simultaneously (BILATERAL trials). Quantitative and qualitative visual field differences were identical to those found when observers used a more natural response output order, treating the top letter of the trigram as the first letter. The results suggest that, regardless of output order, attention is distributed across the three letters in a relatively slow, top-to-bottom fashion on LVF/RH and BILATERAL trials, whereas attention is distributed more rapidly and evenly across the three letters on RVF/LH trials.

A descriptive survey of pediatric human immunodeficiency virus-infected long-term survivors

OBJECTIVE

To identify the population of human immunodeficiency virus-infected pediatric long- term survivors (LTS) followed in major medical institutions in California, Florida and New Jersey.

METHODS

A cross-sectional survey was performed with data collection forms sent to all investigators. Demographic, clinical, and laboratory data were obtained on all living patients >/=8 years infected in the perinatal period with human immunodeficiency virus.

RESULTS

A total of 143 perinatally infected and 54 children infected by neonatal transfusion were identified. Fifty-four children (27%) had absolute CD4 counts >/=500 cells/mm (group 1: mean age 9.8 years), 54 children (27%) had CD4 counts between 200 and 500 cells/mm (group 2: mean age 10.1 years), and 89 children (45%) had CD4 counts <200 cells/mm (group 3: mean age 10.4 years). Ninety-five (48%) patients had developed AIDS defining conditions; 14 (26%) in group 1, 26 (48%) in group 2, and 55 (62%) in group 3. Ninety-two percent of patients had received antiretrovirals. Perinatally human immunodeficiency virus-infected children tended to be younger (mean age 9.8 years) than children infected via a blood transfusion (mean age 11 years). Generalized lymphadenopathy was the most prevalent clinical finding. Lymphoid interstitial pneumonia and recurrent bacterial infections were the most prevalent acquired immune deficiency syndrome-defining conditions. Twenty percent of LTS had CD4 counts >/=500 cells/mm and no immune deficiency syndrome-defining conditions.

CONCLUSIONS

Pediatric LTS were in variable stages of disease progression. The proportion of children within each CD4 strata did not differ by mode of acquisition of infection. Increased CD4 counts were inversely proportional to age. Only 20% of pediatric LTS had minimal to no disease progression.

Ability of laying hens to negotiate horizontal perches at different heights, separated by different angles

1. This paper describes how birds move between horizontal perches at different heights with different angles separating them, using the time to complete the task and the number of birds failing to indicate ability. 2. For the first experiment, 4 groups of 15 birds (ISA Brown) were subjected to each of the experimental treatments (using three perches with angles of 0 degree (horizontal control), 30 degrees, 45 degrees or 60 degrees between them). The birds were required to move upward between the perches for each treatment and then to move downward between the perches, as a second part of the experiment. 3. Birds moving up between the perches took significantly longer at 60 degrees than at any other angle. No birds failed to complete the task. 4. For birds moving downward between the perches, the median time to complete the task increased significantly with angle. Furthermore, the number of birds failing to complete the task increased with angle. 5. A second experiment was conducted to test whether the vertical or horizontal component of distance affected birds' ability to negotiate perches separated by different angles. 6. For the second experiment 4 groups of 10 Lohmann Brown laying hens were subjected to each of the following treatments: two horizontal perches separated by 30 degrees or 60 degrees and either directly, horizontally or vertically separated by a set distance of 50 cm. Birds were required to move both up and down between perches. 7. Birds negotiated horizontally-separated perches more successfully at 30 degrees than at 60 degrees. However, when the vertical distance between the perches was 50 cm there was no significant difference in the ability of birds to move downward at 30 degrees or 60 degrees. For birds moving upward, 60 degrees was easier to negotiate than 30 degrees. 8. The vertical and horizontal separations, as well as the different angles affected the ability of birds to move between perches. There was a general decreasing trend in ability with increasing vertical separation between perches. 9. The findings are important in terms of arrangements of perches to improve bird welfare. To minimise the risk of injury, the angle between perches at different heights should be no more than 45 degrees, and the horizontal and vertical distances between these perches minimised, to allow the birds to be able to move downwards more easily.

Working practices in a perchery system, using the OVAKO Working posture Analysing System (OWAS)

Stockworkers should be able to easily manage alternative systems for commercial egg production. Such production systems can be analysed in terms of human welfare, based on ergonomic criteria. Work-related postures can cause discomfort and strain to workers (Stoffert, 1985). The OVAKO Working posture Analysing System (OWAS) developed in 1974 (Karhu et al, 1977) defines body positions during working practices and scores them according to the strain caused. This technique has so far not been used to assist in the design of working systems for the poultry industry. This pilot study was carried out to determine if such a technique could be easily applied to a perchery system and whether it could lead to an improved design. The stockworker was video recorded performing normal duties within the perchery and the positions of the body were assessed, using the OWAS system. It was found that manual collection of floor eggs and reaching into the middle of the perches from the litter side put the most strain on the stockworker. Modification of the perchery, in light of these results, will establish an improved perchery system for the stockworkers.

Immunological correlates of disease severity in pediatric slow progressors with human immunodeficiency virus type 1 infection

Pediatric slow progressors are a group of HIV-1-infected individuals who are homogeneous for route and length of infection and standard of care and are therefore amenable to cross-sectional population studies on the immunological correlates of disease progression. We report here that both clinical and immunological categorizations of pediatric slow progressors based on the 1994 CDC criteria for symptom and immunosupression severity levels yield similar immunological findings: declining proportions of CD4 T cells are associated with increasing proportions of CD8 and CD4-CD8- T cells and with declining IL-2, -5, and -10 production levels by peripheral blood cells in response to the T cell-dependent mitogen, phytohemagglutinin, but not to the T and B cell-dependent mitogen from pokeweed. The latter cross-sectional results point to potential prognostic and nosologic markers and therapeutic targets among HIV-infected pediatric slow progressors. Longitudinal studies will help to assess further the relevance of these findings.

Nutritive value of subterranean clover in a temperate environment

A study was made over 2 years of the nutritive value of the subterranean clover (Trifolium subterraneum L.) cultivars, Trikkala, Larisa and Goulburn, in grazing experiments with Border Leicester x Merino lambs. Liveweight gain was similar for all cultivars in the first year and in the second year was higher on Larisa (153 g/day) compared with Goulburn and Trikkala (131 and 103 g/day, respectively). Wool growth was not significantly different between cultivars. Both the digestibility and water-soluble carbohydrate content of the petiole and stem plant fraction were significantly (P<0.05) higher than those of the leaf fraction, even though the leaf had a lower level of cell wall organic matter. The ratio of lignin to cell wall organic matter was also higher in the leaf fraction. Samples obtained via oesophageal fistula showed that petioles comprised most of the dry matter in the diet and, thus, were the major contributor to energy supply. Differences were found in the degradability characteristics of the 3 cultivars which led to significant (P<0.05) differences in the concentration of rumen degradable dry matter and effective rumen degradable protein (ERDP). During the vegetative and early flowering stages, the concentration of ERDP exceeded the supply of fermentable metabolisable energy required for microbial protein synthesis. In mature clover, the concentration of ERDP was low and limiting microbial protein synthesis. The degradation characteristics of protein were highly correlated with liveweight gain (r2 = 0.90) and wool growth (r2 = 0.70). It is suggested that increasing the petiole : leaf ratio could increase the efficiency of utilisation of subterranean clover diets.

The effects of HIV on cognitive and motor development in children born to HIV-seropositive women with no reported drug use: birth to 24 months

OBJECTIVE

This study documents delays in the mental and motor functioning of infants perinatally infected with human immunodeficiency virus (HIV) while controlling for confounding effects of prenatal drug exposure, ethnicity, socioeconomic status, and maternal separation and death.

METHODS

The cognitive and motor development of 126 infants born to nondrug-using, HIV-seropositive Haitian women was assessed at 3-month intervals through 24 months of age using the Bayley Scales of Infant Development. By 18 months of age, 28 of the infants were diagnosed as HIV-infected, and the 98 uninfected infants served as a control group. The infected and uninfected infants did not differ with respect to mean gestational age, birth weight, ethnicity, or rates of maternal separation and death.

RESULTS

By 3 months of age, the mean mental and motor scores of the infected infants were significantly lower than those of the uninfected controls. Furthermore, the initial differences between the two groups increased over time, as many of the infected infants became increasingly delayed. Although the infected infants tended to perform more poorly than the uninfected infants, nearly one third of the infected infants exhibited relatively normal cognitive development and half demonstrated relatively normal motor development.

CONCLUSIONS

Over the first 24 months of life, the mean rate of development of HIV-infected infants is significantly slower than that of noninfected infants born to seropositive mothers. This occurs even when the effects are not confounded with those of prenatal drug exposure.

Ossification in choroidal melanoma

Images

Effect of corticosteroids on survival of children with acquired immunodeficiency syndrome and Pneumocystis carinii-related respiratory failure

The medical records of patients with acquired immunodeficiency syndrome were reviewed to evaluate the effect of our adoption to the pediatric population of the National Institutes of Health recommendation for adjunctive corticosteroid therapy in adults with Pneumocystis carinii pneumonia. In 21 episodes of P. carinii-related respiratory failure, only adjunctive corticosteroids were associated with a significant improvement in survival to successful removal of the tracheal tube, from a historical rate of 11% to 91%.

Functional evidence that the principal DNA replication origin of the Streptomyces coelicolor chromosome is close to the dnaA-gyrB region

The degree of overrepresentation of selected chromosomal genes in rapidly growing cultures of Streptomyces coelicolor was assessed by quantitative DNA hybridization analysis. The results are consistent with the hypothesis that the principal origin of replication is close to the dnaA-gyrB region, in the center of the linear chromosome, and that replication proceeds bidirectionally.

Clinical and immunological correlates of immune-complex-dissociated HIV-1 p24 antigen in HIV-1-infected children

It has been reported that HIV-1 p24 antigen (p24 Ag) detection is improved after dissociation of immune complexes using acid treatment (ICD assay). In order to evaluate the clinical significance of p24 Ag detected by the standard assay and by the ICD assay in pediatric patients, we related these measurements to clinical status, level of p24 antibody, and percentage of CD4+ lymphocytes. Fifty-nine plasma specimens from 20 symptomatic HIV-1-infected children, collected prospectively over a 1-year period, were tested for these markers. Plasma was collected at the beginning of zidovudine therapy and approximately 7 and 12 months thereafter. Compared with the standard assay, the ICD assay showed a higher number of samples positive for p24 Ag (78% versus 34%) and an increase in the levels of p24 Ag (median value of 129 versus 24 pg/ml). The anti-p24 antibody level was inversely correlated with the p24 Ag level measured by either assay. Four children negative for p24 Ag by both assays had a stable clinical course. In contrast, 50% of the children negative by the standard assay but positive for ICD p24 Ag and 75% of the children positive by both assays had progression of disease. No patients were positive by the standard assay but negative by the ICD assay. Children whose plasma tested positive by both assays had lower percentages of lymphocytes that were CD4+ by comparison with children who were negative by both assays; children whose plasma tested positive only by the ICD assay formed an intermediate group.(ABSTRACT TRUNCATED AT 250 WORDS)

The pharmacokinetics and safety of zidovudine in the third trimester of pregnancy for women infected with human immunodeficiency virus and their infants: phase I acquired immunodeficiency syndrome clinical trials group study (protocol 082). Zidovudine Collaborative Working Group

OBJECTIVES

We measured the pharmacokinetics and safety of zidovudine in pregnant women infected with human immunodeficiency virus and their offspring.

STUDY DESIGN

Asymptomatic human immunodeficiency virus-infected women with uncomplicated singleton gestations (28 to 36 weeks) underwent parenteral and oral zidovudine treatment during pregnancy and labor. Maternal and neonatal drug levels were measured at delivery and sequentially for 48 hours. Infants were followed up for 18 months.

RESULTS

The total body clearance (26.3 +/- 10.1 ml/min/kg), mean terminal elimination phase zidovudine half-life (1.3 +/- 0.2 hours), and urinary zidovudine recovery were similar to values in nonpregnant adults. Essentially equivalent zidovudine levels in the mother and neonate at delivery implied little, if any, fetal zidovudine metabolism. The half-life of zidovudine in the neonates was tenfold that of the mother. No significant adverse effects were noted in the infant at birth or on follow-up.

CONCLUSIONS

In both mothers and infants the drug appeared safe and well tolerated with no significant hematologic abnormalities.

Thermal stress on chickens in transit

1. An artificial chicken, 'Gloria', was constructed to simulate heat exchanges of poultry during transport. Tests of the instrument in a wind tunnel showed it to have insulation properties similar to that of a live bird. 2. Gloria accompanied chickens in two types of transport modules, A (enclosed) and B (open). The average temperature difference between inside and outside the loaded vehicles when stationary and in motion were 14.0 and 7.6 for Type A and 8.8 and 6.0 for Type B. Average air movement while vehicles were in motion was 0.5 m/s for Type A and 3.3 m/s for Type B. 3. Measurements of sensible heat loss from Gloria at different temperatures and wind speeds were compared with published estimates of thermoneutral heat production and thermal insulation for well and poorly feathered chickens to estimate the range of thermal stresses likely to be experienced by chickens in transit. 4. The results showed that the combination of circumstances necessary to ensure thermal comfort for birds both at rest and in motion is very rare (e.g. only between 7 and 8 degrees C for well feathered birds in enclosed vehicles). It is, however, possible to ensure thermal comfort over a wide range of ambient air temperatures by appropriate control of air movement within the vehicle whether at rest or in motion.

Prognostic significance of oral lesions in children with perinatally acquired human immunodeficiency virus infection

OBJECTIVE

To assess the prevalence and prognostic significance of oral lesions in children with human immunodeficiency virus infection.

DESIGN

Clinical cohort study.

SETTING

Children's Hospital Center at Jackson Memorial Hospital, Miami, Fla.

PARTICIPANTS

Ninety-nine children with perinatally acquired human immunodeficiency virus infection examined longitudinally for oral lesions.

INTERVENTIONS

None.

MEASUREMENTS/MAIN RESULTS

Presence of oral lesions was determined by a pediatrician who had been trained in the diagnosis of oral lesions. The cumulative prevalence of lesions was 72% for oral candidiasis, 47% for parotid enlargement, and 24% for herpes simplex. The median time from birth to development of a lesion was 2.4 years for candidiasis, 4.6 years for parotid enlargement, and 5 years for herpes simplex. The median time from lesion to death was 3.4 years for patients with candidiasis, 5.4 years for patients with parotid enlargement, and 4.3 years for patients with herpes simplex. In a time-dependent proportional-hazards model, oral candidiasis was associated with a more rapid rate of progression to death (relative hazard, 14.2; 95% confidence interval, 4.8 to 41.8), while parotid enlargement was associated with a less rapid rate of progression to death (relative hazard, 0.38; 95% confidence interval, 0.16 to 0.88) and herpes simplex was unrelated to the rate of progression (relative hazard, 1.3; 95% confidence interval, 0.5 to 3.1).

CONCLUSIONS

The presence of oral candidiasis and parotid enlargement confer important prognostic information and should be incorporated into decisions regarding therapy for HIV-infected children.

Retinal antigen specific lymphocytes, TCR-gamma delta T cells and CD5+ B cells cultured from the vitreous in acute sympathetic ophthalmitis

CD5+ B lymphocytes and TCR gamma-delta T lymphocytes, phenotypes implicated in the pathogenesis of autoimmune disease, were isolated from the vitreous in a case of acute sympathetic ophthalmitis. These cells were obtained using a method which allows the selective maintainance in vitro of in vivo activated T lymphocytes. Dual colour flow cytometry showed that after 3 days culture in IL-2 containing medium 61% of cells were CD5/CD19 + ve and 41% CD3/TCR gamma delta + ve. Of the total CD3 + ve population, 15% were gamma/delta negative. These cells formed a population which also responded in a proliferation assay to retinal antigens. Histologically the eye showed a marked mononuclear cell infiltration of the retina, ciliary body and choroid. Granulomatous lesions within the choroid contained lymphocytes, plasma cells and multinucleate giant cells. Immunocytochemistry showed lymphocyte populations to be predominantly CD2 + ve CD3 + ve T lymphocytes of the CD4 sub-set. Distribution of monocytes/macrophages throughout the lesions and restriction of B-lymphocytes to granulomata were all consistent with a DTH type reaction. Despite immunosuppressive therapy, the expression of activation antigens HLA-DR and ICAM-1 on infiltrating and resident ocular tissue cells was high, although IL-2 receptor (CD25) expression was virtually absent. Flow cytometric analysis of peripheral blood cells prior to treatment with Cyclosporin-A showed systemic activation of lymphocytes, with high levels of HLA-DR and CD25 expression and a raised CD4/CD8 ratio.